Synthetic aperture imaging in breast ultrasound: a preliminary clinical study

Whole-Body Imaging Using Low Frequency Transmission Ultrasound

RATIONALE AND OBJECTIVES

To indicate that 3D low-frequency ultrasound tomography with 3D data acquisition (volography) is a safe, low-cost, high-resolution, whole-body meso-scale medical imaging modality that gives high-resolution quantitatively accurate clinically relevant images.

MATERIALS AND METHODS

We compare the speed of sound accuracy in various organs in situ. We validate our 3D ultrasound tomography images using MRI and gross section anatomy as ground truth in 10-day old piglets. Data acquisition is accomplished with the QT Scanner at ∼1 MHz center frequency, and array transceivers for reflection data @3.6 MHz. Images are generated with unique model-based 3D ultrasound tomography algorithms. In reflection, we use 3D refraction-corrected ray tracing to allow 360° compounding with sub-mm resolution. Four 10-12 day old pigs were anesthetized and whole-body images were acquired via low-frequency transmitted ultrasound and 3T MRI.

RESULTS

Tissue values were within an average of 1.07% (0.5%) of the literature values. We also show the detailed correlation of our images with MRI images in axial, coronal, and sagittal views. Volography images of a piglet show high resolution and quantitative accuracy, showing more contrast &resolution than 3T MRI, including the kidney showing medulla, cortex and fibrous cover, and small intestines with ileal lumen detail visible.

CONCLUSION

We establish that 3D ultrasound tomography (volography), yields high-resolution quantitatively accurate images whole-body images in presence of bone and air which are potentially clinically useful but have not appeared in the literature.

Low frequency 3D transmission ultrasound tomography: technical details and clinical implications

A novel 3D ultrasound tomographic (3D UT) method (called volography) that creates a speed of sound (SOS) map and a reflection modality that is co-registered are reviewed and shown to be artifact free even in the presence of high contrast and thus shown to be applicable for breast, orthopedic and pediatric clinical use cases. The 3D UT images are almost isotropic with mm resolution and the reflection image is compounded over 360 degrees to create sub-mm resolution in plane.

METHODS

The physics of ultrasound scattering requires 3D modeling and the concomitant high computational cost is ameliorated with a bespoke algorithm (paraxial approximation - discussed here) and Nvidia GPUs. The resulting reconstruction times are tabulated for clinical relevance. The resulting SOS map is used to create a refraction corrected reflection image at ∼3.6 MHz center frequency. The transmission data are highly redundant, collected over 360 degrees and at 2 mm levels by true matrix receiver arrays yielding 3D data. The high resolution SOS and attenuation maps and reflection images are used in a segmentation algorithm that optimally utilizes this information to segment out glandular, ductal, connective tissue, fat and skin. These volumes are used to estimate breast density, an important correlate to cancer.

RESULTS

Multiple SOS images of breast, knee and segmentations of breast glandular and ductal tissue are shown. Spearman rho is calculated between our volumetric breast density estimates and Volpara™ from mammograms, as 0.9332. Multiple timing results are shown and indicate the variability of the reconstruction times with breast size and type but are ∼30 minutes for average size breast. The timing results with the 3D algorithm indicate ∼60 minute reconstruction times for pediatrics with two Nvidia GPUs. Characteristic variations of the glandular and ductal volumes over time are shown. The SOS from QT images are compared with literature values. The results of a multi-reader multi-case (MRMC) study are shown that compares the 3D UT with full field digital mammography and resulted in an average increase in ROC AUC of 10%. Orthopedic (knee) 3D UT images compared with MRI indicate regions of zero signal in the MRI are clearly displayed in the QT image. Explicit representation of the acoustic field is shown, indicating its 3D nature. An image of in vivo breast with the chest muscle is shown and speed of sound agreement with literature values are tabulated. Reference is made to a recently published paper validating pediatric imaging.

CONCLUSIONS

The high Spearman rho indicates a monotonic (not necessarily linear) relation between our method and industry gold standard Volpara™ density. The acoustic field verifies the need for 3D modeling. The MRMC study, the orthopedic images, breast density study, and references, all indicate the clinical utility of the SOS and reflection images. The QT image of the knee shows its ability to monitor tissue the MRI cannot. The included references and images herein indicate the proof of concept for 3D UT as a viable and valuable clinical adjunct in pediatric and orthopedic situations in addition to the breast imaging.

Synthetic Aperture Focusing for Multi-Covariate Imaging of Sub-Resolution Targets

Coherence-based imaging methods suffer from reduced image quality outside the depth of field for focused ultrasound transmissions. Synthetic aperture methods can extend the depth of field by coherently compounding time-delayed echo data from multiple transmit events. Recently, our group has presented the Multi-covariate Imaging of Sub-resolution Targets (MIST), an estimation-based method to image the statistical properties of diffuse targets. MIST has demonstrated improved image quality over conventional delay-and-sum, but like many coherence-based imaging methods, suffers from limited depth of field artifacts. This article applies synthetic aperture focusing to MIST, which is evaluated using focused, plane-wave, and diverging-wave transmit geometries. Synthetic aperture MIST is evaluated in simulation, phantom, and in vivo applications, demonstrating consistent improvements in contrast-to-noise ratio (CNR) over conventional dynamic receive MIST outside the transmit depth of field, with approximately equivalent results between synthetic transmit geometries. In vivo synthetic aperture MIST images demonstrated 16.8 dB and 16.6% improvements in contrast and CNR, respectively, over dynamic receive MIST images, as well as 17.4 dB and 32.3% improvements over synthetic aperture B-Mode. MIST performance is characterized in the space of plane-wave imaging, where the total plane-wave count is reduced through coarse angular sampling or total angular span. Simulation and experimental results indicate wide applicability of MIST to synthetic aperture imaging methods.

Comparison of virtual source synthetic aperture beamforming with an element-based model

Ultrasound beamforming relies on models of propagation to convert samples of the backscattered field through time into spatial image samples. The most common model is straight-line propagation of a focused wave, assuming a narrow steered and focused beam that propagates along a selected direction. The reconstructed image suffers from defocusing, reduced signal-to-noise ratio (SNR), and contrast loss away from the focus. "Virtual source" methods coherently combine the recorded data from multiple transmissions to form a synthetic transmit focus by making geometric assumptions about the transmissions. These also include diverging waves (virtual source behind the array) and plane waves (virtual source at infinity). Retrospective encoding for conventional ultrasound sequences (REFoCUS) beamforming has been proposed to instead model transmission as the superposition of the responses of individual transmit elements on the transducer array and to efficiently estimate the "complete data set"-individual element transmit and receive responses. In addition to isolating individual element contributions, the result of this unifying framework is a high-SNR, two-way focused image from focused plane wave or diverging transmissions. No significant differences were observed for either SNR or image quality measured by contrast-to-noise ratio between the appropriate virtual source method and REFoCUS beamforming in simulation and experimental imaging.

Effects of line fiducial parameters and beamforming on ultrasound calibration

Ultrasound (US)-guided interventions are often enhanced via integration with an augmented reality environment, a necessary component of which is US calibration. Calibration requires the segmentation of fiducials, i.e., a phantom, in US images. Fiducial localization error (FLE) can decrease US calibration accuracy, which fundamentally affects the total accuracy of the interventional guidance system. Here, we investigate the effects of US image reconstruction techniques as well as phantom material and geometry on US calibration. It was shown that the FLE was reduced by 29% with synthetic transmit aperture imaging compared with conventional B-mode imaging in a Z-bar calibration, resulting in a 10% reduction of calibration error. In addition, an evaluation of a variety of calibration phantoms with different geometrical and material properties was performed. The phantoms included braided wire, plastic straws, and polyvinyl alcohol cryogel tubes with different diameters. It was shown that these properties have a significant effect on calibration error, which is a variable based on US beamforming techniques. These results would have important implications for calibration procedures and their feasibility in the context of image-guided procedures.

Ultrasound Vector Flow Imaging-Part II: Parallel Systems

This paper gives a review of the current state-of-the-art in ultrasound parallel acquisition systems for flow imaging using spherical and plane waves emissions. The imaging methods are explained along with the advantages of using these very fast and sensitive velocity estimators. These experimental systems are capable of acquiring thousands of images per second for fast moving flow as well as yielding the estimates of low velocity flow. These emerging techniques allow the vector flow systems to assess highly complex flow with transitory vortices and moving tissue, and they can also be used in functional ultrasound imaging for studying brain function in animals. This paper explains the underlying acquisition and estimation methods for fast 2-D and 3-D velocity imaging and gives a number of examples. Future challenges and the potentials of parallel acquisition systems for flow imaging are also discussed.

Clinical evaluation of synthetic aperture harmonic imaging for scanning focal malignant liver lesions

The purpose of the study was to perform a clinical comparison of synthetic aperture sequential beamforming tissue harmonic imaging (SASB-THI) sequences with a conventional imaging technique, dynamic receive focusing with THI (DRF-THI). Both techniques used pulse inversion and were recorded interleaved using a commercial ultrasound system (UltraView 800, BK Medical, Herlev, Denmark). Thirty-one patients with malignant focal liver lesions (confirmed by biopsy or computed tomography/magnetic resonance) were scanned. Detection of malignant focal liver lesions and preference of image quality were evaluated blinded off-line by eight radiologists. In total, 2,032 evaluations of 127 image sequences were completed. The sensitivity (77% SASB-THI, 76% DRF-THI, p = 0.54) and specificity (71% SASB-THI, 72% DRF-THI, p = 0.67) of detection of liver lesions and the evaluation of image quality (p = 0.63) did not differ between SASB-THI and DRF-THI. This study indicates the ability of SASB-THI in a true clinical setting.

Clinical evaluation of synthetic aperture sequential beamforming ultrasound in patients with liver tumors

Medical ultrasound imaging using synthetic aperture sequential beamforming (SASB) has for the first time been used for clinical patient scanning. Nineteen patients with cancer of the liver (hepatocellular carcinoma or colorectal liver metastases) were scanned simultaneously with conventional ultrasound and SASB using a commercial ultrasound scanner and abdominal transducer. SASB allows implementation of the synthetic aperture technique on systems with restricted data handling capabilities due to a reduction in the data rate in the scanner by a factor of 64. The image quality is potentially maintained despite the data reduction. A total of 117 sequences were recorded and evaluated blinded by five radiologists from a clinical perspective. Forty-eight percent of the evaluations were in favor of SASB, 33% in favor of conventional ultrasound and 19 % were equal, that is, a clear, but non-significant trend favoring SASB over conventional ultrasound (p = 0.18), despite the substantial data reduction.

Synthetic aperture focusing for short-lag spatial coherence imaging

It has been demonstrated that short-lag spatial coherence (SLSC) ultrasound imaging can provide improved speckle SNR and lesion CNR compared with conventional Bmode images, especially in the presence of noise and clutter. Application of the van Cittert-Zernike theorem predicts that coherence among the ultrasound echoes received across an array is reduced significantly away from the transmit focal depth, leading to a limited axial depth of field in SLSC images. Transmit focus throughout the field of view can be achieved using synthetic aperture methods to combine multiple transmit events into a single final image. A synthetic aperture can be formed with either focused or diverging transmit beams. We explore the application of these methods to form synthetically focused channel data to create SLSC images with an extended axial depth of field. An analytical expression of SLSC image brightness through depth is derived for the dynamic receive focus case. Experimental results in a phantom and in vivo are presented and compared with dynamic receive focused SLSC images, demonstrating improved SNR and CNR away from the transmit focus and an axial depth of field four to five times longer.